Healthcare Provider Details

I. General information

NPI: 1821083205
Provider Name (Legal Business Name): CLAY CENTER FAMILY PHYSICIANS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 LIBERTY ST
CLAY CENTER KS
67432-1564
US

IV. Provider business mailing address

609 LIBERTY ST
CLAY CENTER KS
67432-1564
US

V. Phone/Fax

Practice location:
  • Phone: 785-632-2181
  • Fax: 785-632-2309
Mailing address:
  • Phone: 785-632-2181
  • Fax: 785-632-2309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateKS

VIII. Authorized Official

Name: ROXANNE SCHOTTEL
Title or Position: ADMINISTRATIVE SUPERVISOR
Credential:
Phone: 785-632-2181